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Research Summary

INSAR 2025: Anxiety Diagnoses in Autistic Preschoolers

Dr. Fakhri Shafai
The International Society for Autism Research (INSAR) Conference is the largest autism research conference in the world. The 2025 conference took place April 30 – May 3 in Seattle, Washington. Anxiety in Autistic children was a focus of some of this year's sessions. In this research summary, researchers from the United States reported their findings looking at types of anxiety in Autistic preschoolers of different genders, speaking ability, and with and without co-occurring intellectual disability

About INSAR:

The International Society for Autism Research (INSAR) Conference is the largest autism research conference in the world. The 2025 conference took place April 30 – May 3 in Seattle, Washington. This conference is a mixture of oral presentations, panel discussions, poster sessions, and special interest group meetings on topics important to the autism and research communities. Topics for the conference are submitted by researchers and autism community members and chosen by the INSAR committee.

 

INSAR 2025 Session: Anxiety – The Spectrum of Impacts Across Age, Sex and Cognitive Functioning

Presentation: Anxiety Diagnoses in Very Young Autistic Children with Varying Intellectual Abilities

Presenting Author: A. L. Hogan, University of South Carolina

Additional Authors: K. E. Caravella, University of North Carolina; J. Smith, University of South Carolina; K. Hills, University of South Carolina; A. S. Carter, University of Massachusetts; J. Roberts, University of South Carolina

 

Study Background: While it is well known that Autistic people have an increased likelihood of having a co-occurring anxiety disorder, little is known about how anxiety symptoms present in early childhood. Knowing whether a young child has anxiety, and if so, which kind of anxiety is important. Specific interventions for different types of anxiety may help prevent the anxiety from getting worse as they age1. One challenge with diagnosing anxiety in young Autistic children is that many of the tools used were designed for older children. Additionally, some of these tools may not be as accurate for children with co-occurring spoken language and/or cognitive challenges.

 

INSAR Presentation: How do we diagnose anxiety in Autistic preschoolers with different intellectual abilities?

Forty-seven Autistic preschoolers and 31 non-Autistic preschoolers were included in this study. All children were assessed for anxiety using a clinical best estimate (CBE) procedure that combined different questionnaire tools, direct observations, parental interviews, and clinical judgement. Forty-eight percent of the Autistic preschoolers met the criteria for an anxiety disorder diagnoses, compared to 26% of non-Autistic preschoolers. The most common form of anxiety was ‘specific phobia’, meaning that the fear and worry about one particular issue (e.g., dogs, loud noises, etc.) was disruptive enough that it was classified as a disorder.

The rates of anxiety in Autistic children were similar across the subgroups, meaning that there was no difference in children regardless of gender, co-occurrence of intellectual disability, or those who were non-speaking versus speaking. While this study had a relatively small sample size, the findings suggest that 1) using CBE approaches to studying anxiety in this age group is worthwhile for clinicians assessing anxiety in this age group, and 2) anxiety is very common for Autistic preschoolers of all intellectual abilities.

 

General Background: What are the different types of anxiety disorders in children?

While some fears and anxieties are a typical part of development, they can cross into the territory of ‘disorder’ if the worry and reaction is longer and more intense than would be expected typically of children in that age group.

  • Separation Anxiety: Excessive fear of being separated from their caregiver and/or a specific object. May struggle sleeping alone and avoid activities or locations (e.g., school) where they are expected to be separated from the desired person and/or preferred object.
  • Social Phobia: Excessive fear of social situations or potential social rejection. May avoid social settings due to previous bullying and this can be generalized (e.g., everywhere outside of the home) or in specific locations (e.g., school playground).
  • Generalized Anxiety Disorder (GAD): Excessive worry about most things in daily life, including the future, illness, school, accidents, etc. May lead to an unwillingness to try new things and potentially impact sleep.
  • Specific Phobia: Excessive fears and sensitivity to certain animals, objects, or sensory experiences (e.g., alarms). The worry about encountering a specific phobia can lead to avoidance of certain activities.
  • Obsessive Compulsive Disorder (OCD)*: People with this disorder have persistent and unwanted thoughts (obsessions) and repetitive actions, mental acts, and urges (compulsions) that feel out of control. While OCD is most often diagnosed between the ages of 8 and late teen years, it can be diagnosed in children as young as 4 or 5 years of age. OCD compulsions can be challenging to distinguish from the repetitive behaviours of autism.
  • Post-traumatic Stress Disorder (PTSD)**: People who have experienced a profound trauma (e.g., abuse, neglect, witnessing a traumatic event, etc.) can develop PTSD. They may relive the event (flashbacks), change their behaviour, avoid reminders of the event, and have regression following the trauma.

 

*Please note that obsessive compulsive disorder (OCD) used to be classified as an anxiety disorder, but under the Fifth Edition of Diagnostics and Statistical Manual for Mental Health Disorders (DSM-V), it is now classified as a distinct type of disorder2. Older anxiety questionnaires often still include it as a type of anxiety disorder.

**Please note that Post-Traumatic Stress Disorder (PTSD) is a more complex diagnostic process and should be assessed with a clinician specialized in psychiatric trauma in young children.

 

How can we measure anxiety in Autistic preschoolers?

The Spence Preschool Anxiety Scale Revised (PASR)3 is a parent-report questionnaire with 28 questions about different aspects of anxiety that their preschool-aged child may exhibit. It was adapted from the Spence Childhood Anxiety Scale and has four subscales: Social Anxiety, Separation Anxiety, Specific Fears, and Generalized Anxiety. The responses are scored between 0 (‘Not True at All’) and 4 (‘Very Often True’) with a maximum score of 112. While this is not a diagnostic tool (meaning it is alone not enough to officially diagnose someone with an anxiety disorder), scores that are high in one or more categories may indicate that the child should be assessed for an anxiety disorder by a professional.  

Question 29 is not scored and is an open-ended place to describe any traumatic events the child has experienced, with five additional questions to assess whether the child is exhibiting any behaviours that may indicate PTSD.

 

The French version of the Spence Preschool Anxiety Scale is only available in the earlier edition (before it was revised), but the scoring is similar. In addition to the four subscales of the revised edition, there is an additional subscale for OCD behaviours4. The scoring guide is only available in English.

 

What can I do with this information?

If you have concerns about your preschool-aged child’s anxiety, it can be helpful to share a completed questionnaire with your child’s pediatrician or other medical professionals. These questionnaires help to provide evidence of the type(s) of anxiety your child is experiencing and may give some insights into the best way to approach supporting your child with their anxiety. You can also ask for your child to be assessed using the Clinical Best Estimate (CBE) approach that the presenting researchers used in their study.

 

Are there any other resources I can try to help my preschooler with their anxiety?

AIDE Canada has several toolkits and videos that provide you with more information and may help you support your Autistic preschooler with their anxiety.

The AIDE Canada Library has useful book suggestions:

Books in French:

 

References:

  1. Adams, D., Malone, S., Dargue, N., Keen, D., Rodgers, J., Simpson, K., ... & Rapee, R. (2024). Prevention and Reduction of Anxiety in Autistic Preschoolers Through an Autism-Specific Parent-Mediated Intervention: A Pilot Randomised Controlled Trial Evaluating Short and Longer Term Outcomes. Journal of Autism and Developmental Disorders, 1-17. DOI: 10.1007/s10803-024-06570-5
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
  3. Edwards SL, Rapee RM, Kennedy SJ, Spence SH. The assessment of anxiety symptoms in preschool-aged children: the revised Preschool Anxiety Scale. J Clin Child Adolesc Psychol. 2010;39(3):400-9. DOI: 10.1080/15374411003691701. PMID: 20419580.
  4. Spence, S.H., Rapee, R., McDonald, C., & Ingram, M. (2001). The structure of anxiety symptoms among preschoolers. Behaviour Research and Therapy, 39, 1293 - 1316. DOI: 10.1016/s0005-7967(00)00098-x

 

 

Photo by cottonbro studio on Pexels

 

 

Keywords•
Across Canada , anxiety and stress , Developmental Disabilities (DD) , Mental Health , Research ,
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